Your doctor needs to find the cause of your breathlessness to find the best treatment for you.
They will ask lots of questions about your health and your breathing problems. This can feel like a lot to deal with if you are very breathless and tired. You might just want your doctor to give you medicine to help with breathing straight away. If you find it hard to answer the questions your family and friends might be able to help.
Your doctor will examine you. This might include:
- examining your chest and tummy area (abdomen)
- asking you to blow into a tube to measure how much air you can breathe in and blow out (peak flow)
- taking your blood pressure and pulse
- measuring how well oxygen is travelling around the body
To get more information about your breathlessness, you might have one or more of the following tests:
- a chest x-ray
- CT scan
- lung function tests
- blood tests
Finding the right treatment
Your treatment depends on what is causing your breathlessness. There may be several causes. It might be possible to treat some of the causes and still not fully relieve the breathlessness.
Some treatments may have side effects so you might wish to ask your doctor about the risks and benefits of different treatments.
Blood transfusions or iron tablets
If you have mild anaemia, you might just need a course of iron tablets.
With more severe anaemia you may need to have a blood transfusion to bring your red blood cell count up again. You can have a transfusion as an outpatient or stay overnight in hospital. It usually takes between 6 and 9 hours, depending on how many units of blood you need.
The blood is donated by someone else and is screened for different infections. It is very safe and you should feel much better after the transfusion.
Another treatment for anaemia is a drug called erythropoietin (EPO). It encourages your bone marrow to make more red blood cells. Your haemoglobin levels go up and so does the amount of oxygen your blood can carry.
EPO may help if you have myeloma and your anaemia is due to kidney failure. Or if you have ovarian cancer and have had chemotherapy with platinum based drugs, such as carboplatin or cisplatin.
If you have a chest infection, you will probably need a course of antibiotics. You may have these as tablets or as injections into a vein in your arm.
Once your infection is cleared, your breathing will improve.
Fluid on the lungs is called a pleural effusion. The fluid collects between the 2 sheets of tissue covering the outside of the lung (pleura). The fluid takes up space where your lungs should be. It stops your lungs expanding fully. You have to take shorter breaths and need to make more effort to breathe.
It might be possible to have the fluid drained off, but it can often build up again. A procedure called pleurodesis might stop the fluid building up.
Ascites (a-site-eez) is the medical name for fluid on the abdomen.
Ascites pushes up onto the diaphragm which gives it less room to move and causes breathlessness.
If you have ascites, your doctor can put a needle into the abdomen and drain off the fluid. This is called paracentesis (pronounced para-sen-tee-sis) and can help relieve your symptoms and make you feel more comfortable.
If your doctor thinks you will need to have fluid drained regularly, they may suggest a long term tube (catheter).
Laser treatment is a type of surgery. Doctors mostly use laser surgery to treat advanced lung cancer.
They can use it to cut away any tumour that is blocking a main airway and making breathing difficult.
You have this done through a tube down the throat (bronchoscopy). You have an anaesthetic or strong sedation first so you won't remember much, if anything, about it.
Lasers seal off bleeding as they go. So you don't have to stay in hospital for long after the treatment. You may even be able to go home the same day.
Most hospitals that treat lung cancer carry out laser surgery. The operation usually works very well at relieving breathing difficulties. But it is not a cure. It does not treat cancer that has spread anywhere else in the body. The tumour in the airway may grow back.
If necessary, it may be possible for the laser surgery to be done more than once.
Internal radiotherapy is also known as brachytherapy or endobronchial therapy. Doctors might use it to treat a tumour that is partly or completely blocking your airway.
Your doctor puts a tube (bronchoscope) down the back of your throat into your airway. The radiation is directed to very small areas of the lung. This can help make breathing easier and reduce coughing.
If the tubes that carry air into your lungs have narrowed, making breathing difficult, you can take drugs to open them up again.
These drugs are called bronchodilators. You can have them as tablets, inhalers, or through a mask called a nebuliser.
A nebuliser is a machine that makes a mist of tiny drops (an aerosol) out of a liquid drug, which you then breathe in. In hospital, your nebuliser will be attached to the piped air in the ward.
There are home nebuliser kits available to borrow or buy. You may need to have nebulisers as often as every 4 hours, depending on how breathless you are.
Sterile saline (salt water) in a nebuliser may help you if you have a chesty cough. It will loosen phlegm and make it easier for you to bring it up.
For an irritating cough, your doctor may suggest a very small amount of a local anaesthetic called bupivacaine to help suppress it.
Muscle weakness is a cause of breathlessness. Electrical impulses are used to stimulate the nerves in a group of muscles. This can help the muscles to function again.
This treatment is called neuromuscular electrical stimulators (NMES) and might be offered through a breathlessness clinic.
Your doctor might suggest medicines to help your breathing.
If side effects from radiotherapy are making you breathless, your doctor might suggest steroid tablets.
Once your breathing improves, your doctor gradually decreases your dose before stopping them altogether.
You might find the over the counter cough medicines for chesty coughs helpful, but it really depends on what is causing your cough.
Some people find codeine linctus helpful, but it can make you constipated.
Muscle relaxants like diazepam or lorazepam can help you to breathe more fully by relaxing your chest and abdominal muscles.
You can get lorazepam in a tablet you dissolve under your tongue, which means it works fast and is easier than swallowing a tablet.
Breathing problems might make you feel very anxious. These drugs can also help with anxiety.
Opioid painkillers such as morphine can help with breathing problems. They can:
- relieve pain
- slow down your breathing rate (respiration rate)
- improve your sleep
If you are very short of breath, especially when you do any exercise, your doctor might prescribe small morphine doses to help you.
People who are near the end of life may have morphine and other drugs through a syringe driver to help with breathlessness. A syringe driver is a pump that gives drugs at a constant dose. The drugs go through a soft plastic tube to a needle that goes in just under your skin.
If your lungs are producing a lot of secretions, you might find it difficult to breathe. Your doctor can give you drugs to help dry up these secretions and may ease your breathing.
Glycopyrrolate or hyoscine hydrobromide
Hyoscine can also make you quite drowsy. You usually have these drugs through a syringe driver. The pump gives the drug from the syringe through a soft plastic tube to a needle that goes in just under your skin. Your nurse will fix the needle in place with a see through plastic dressing stuck over the top.
They might be mixed with painkillers.
Other drugs such as carbocisteine break down the thickness of your sputum and make it easier to cough up. This can help your breathing. These drugs come as capsules or a syrup.
Your doctor or nurse might suggest relaxation classes, massage or acupuncture to help your breathlessness.
Many hospitals now run breathlessness clinics and these treatments may be available there.
If you are interested in trying a particular complementary therapy, talk to your nurse. If it is not available at your hospital or clinic, there may be a local cancer support group that offers this type of service or at least can put you in touch with local practitioners.
Referral to a breathlessness clinic
Many hospitals have set up specialist breathlessness clinics. It won’t just be people with cancer who go to these clinics. There will be people with chronic lung disease there too.
The clinics are usually run by specialist nurses, occupational therapists and physiotherapists who can help you learn techniques to manage your breathlessness better.
You can learn better breathing techniques, relaxation and how to pace yourself. You usually go to the clinic for 4 to 8 weeks.
The people most likely to benefit are those who are breathless when they are active, but not too bad when sitting at rest.